Article

Use of drug combinations in treatment of opioid withdrawal.

Department of Psychiatry, West Haven VA Hospital, Connecticut 06516.
Journal of Clinical Psychopharmacology (impact factor: 4.1). 07/1992; 12(3):203-9. pp.203-9
Source: PubMed

ABSTRACT During the last 10 years new approaches for rapid opioid detoxification have included drug combinations such as clonidine and naltrexone to speed and ease the transition from opioid agonist to antagonist maintenance. Other drug combinations include naloxone with midazolam or methohexitone for inpatients, but rapid outpatient methods are more desirable. Clonidine combined with naltrexone enables abrupt opioid withdrawal in 3-5 days in an outpatient/day setting. This approach can be further improved by transition to the partial agonist buprenorphine from either heroin or methadone followed by a 1 day detoxification using naltrexone precipitated withdrawal, ameliorated by clonidine.

0 0
 · 
0 Bookmarks
 · 
16 Views
  • Source
    Article: Pharmacological enhancement of naltrexone treatment for opioid dependence: a review.
    Paolo Mannelli, Kathleen S Peindl, Li-Tzy Wu
    [show abstract] [hide abstract]
    ABSTRACT: PURPOSE: Opioid dependence (OD) is a serious and growing clinical condition with increasing social costs that requires expanding treatment beyond opioid agonist substitution. The opioid antagonist naltrexone has displayed a remarkable association of theoretical effectiveness and poor clinical utility in treating OD due to noncompliant behavior and low acceptability among patients, only partly modified by psychosocial interventions. We reviewed pharmacological studies, including naltrexone depot formulations and combination treatments. METHOD: We searched PubMed for clinical studies on the use of naltrexone implants and slow-release injections in OD, and investigations using adjunct medications to improve naltrexone maintenance therapy of OD. We discussed the results in view of their application to the clinical practice. RESULTS: Significant reduction in opioid use and improved retention in treatment have been found in several studies using depot naltrexone formulations, some of which are controlled clinical trials. Pilot investigations have gathered initial positive results on the use of naltrexone in combination with serotonin reuptake inhibitors, α-2 adrenergic, opioid, and γ-aminobutyric acid agonist medications. CONCLUSION: Current evidence suggests that more research on effectiveness and safety is needed in support of depot naltrexone treatment for OD. Further research comparing slow-release with oral naltrexone and opioid agonist medications will help characterize the role of opioid antagonist-mediated treatment of OD. Preliminary investigations on naltrexone combination treatments suggest the opportunity to continue study of new mixed receptor activities for the treatment of OD and other drug addictions.
    Substance abuse and rehabilitation. 06/2011; 2011(2):113-123.
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

1 day detoxification
 
antagonist maintenance
 
Clonidine
 
desirable
 
last 10 years new approaches
 
midazolam
 
naltrexone
 
naltrexone enables abrupt opioid withdrawal
 
outpatient/day
 
partial agonist buprenorphine
 
rapid opioid detoxification
 
rapid outpatient methods